Provider Demographics
NPI:1417141649
Name:TENNISON, JASON W (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:TENNISON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7001
Mailing Address - Country:US
Mailing Address - Phone:817-556-2323
Mailing Address - Fax:
Practice Address - Street 1:843 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7001
Practice Address - Country:US
Practice Address - Phone:817-556-2323
Practice Address - Fax:817-556-3840
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics